CHAPTER THREE
8.0 Concllisions and Recommendations 8.1 Conclusions
CHAPTER EIGHT
8.0 Concllisions and Recommendations
susceptible, similar to what was found in a Swiss study (Braun-Fahrlander, et.
al., 1997).
The influence that factors such as lifestyle and occupational exposure as well as perceptions on air pollution (as was found in the univariate analysis) have on respiratory symptoms can also not be discarded.
The fact that the same risk factors for respiratory symptoms were identified to be important in this study compared to studies from other countries, including first world countries, indicates that the data from this study could be compared with the data from first world countries to determine prevalences of respiratory symptoms.
In conclusion it can be said that although the prevalence of respiratory health symptoms in this selected group of adults, who spent their developing years in a polluted environment, is relatively high, ambient air pollution exposure cannot be considered the only cause since many other risk factors, including factors associated with genetic predisposition, occupation and lifestyle were identified, which indicates that respiratory illnesses are of multi factorial etiology.
82 Recommendations
It is recommended to do a follow-up on the same study population to determine whether respiratory symptoms will increase even more or if a plateau will be reached. Such a study may also indicate whether the effect of exposure to air pollution during childhood might really only become evident much later in life.
Several studies have found that populations with a lower socio-economic status have a lower prevalence of immunological diseases such as allergies and diabetes 1 (Bach, 2002). Long-term exposure to air pollution, might therefore not be a causal factor for the development of asthma and respiratory allergies.
More research addressing vulnerability is therefore needed to understand not only the role of poverty and associated malnutrition, ill health and access to health care, but also the role of rapidly changing lifestyles, diets, and over nutrition among the middle class, in mediating the relationship between air pollution and health.
Indicators other than respiratory illnesses should be investigated to determine the effect of air pollution on the human body, since allergies, genetic predisposition life style and even perception have such a major influence on respiratory diseases.
The role of genetic factors in the persistence of respiratory diseases into adult life should be investigated.
The need for primary health care facilities to cope with chronic diseases should be pro-actively investigated.
This study confirms what was found during the SADHS of 1998, namely that smoking, living in a house where smoking is allowed, being overweight and being occupationally exposed to air pollution (dust and chemicals) are risk factors that should be reduced in order to have a beneficial influence on the prevalence of respiratory symptoms.
REFERENCES
Abbey, D.E., Nishino, N., McDonell, W.F., Burchette, RJ., Knutsen, S.F., Beeson, W.L. and Yang, JX. 1999. Long-Term Inhalable Particles and Other Air Pollutants Related to Mortality in Nonsmokers. American Journal of Respiratory and Critical Care Medicine 159: 373-382.
Ackermann-Liebrlch, U., Leuenberger, P., Schwartz, J., Schindler, C., Monn, C., Bolognini, G., Bongard, J. P., Brandli, 0., Domenighetti, G., Elsasser, S.,
Grize, L., Karrer, W., Keller, R, Keller-Wossidlo, H., KOnzli, N., Martin, B.W., Medici, T. C., Perruchoud, A. P., Sch6ni, M. H., Tschopp, J. M., ViIIiger, B., WGthrich,B., Zellweger,J. P., Zemp, E. and the Study on Air Pollution And Lung Diseases In Adults (SAPALDIA) Team. 1997.Lung Function and Long Term Exposure to Air Pollutants in Switzerland. American Journal of Respiratory and Critical Care Medicine 155: 122-29.
Arbes, S.J., Cohn, RD., Yin, M., Muilenberg, M.L., Friedman, W. and Zeldin, D.C.
2004. Dog Allergen (Can f 1) and Cat Allergen (Fel d 1) in US Homes: Results from the National Survey of Lead and Allergens in Housing. Journal of Allergy and Clinical Immunology 114( 1).
Arif, A. A. , Delcos, G.L., Lee, E.S., Tortolero, S.R and Whitebead, LW. 2003.
Prevalence and Risk Factors of Asthma and Wheezing among US Adults: an Analysis of the NHANES III Data. European Respiratory Journa/21: 827-33.
Avol, E.L., Gauderman, W.J., Tan, S.M., London, S.J. and Peters, J.M. 2001.
Respiratory Effects of Relocating to Areas of Differing Air Pollution Levels.
American Journal of Respiratory and Critical Care Medicine 164(11): 2067-72.
Bach, J. 2002. The effect of infections on Susceptibility to Autoimmune and Allergic Diseases. The New England Journal of Medicine 347:911-20.
Bearer, C.F. 1995. How are Children Different from Adults? Environmental Health Perspectives 103 (6): 7-12.
Beasley, R, Von Mutius, E. and Pearce, N. 1998. Worldwide Variation in Prevalence of Symptoms of Asthma, Allergic Rhinoconjunctivitis, and Atopic Eczema: ISAAC.
The Lancet 351: 1225-32.
Bradshaw, D., Groenewald, P. Laubcher, R, Nannan, N., Nojilana, B., Norman, R, Pieterse, D. and Schneider, M. 2003. Initial Burden of Disease Estimates for South Africa, 2000. South African Medical Research Council Report
ISBN 1-919809-64-3.
Braun-Fahrlander, C., Vuille, J.C., Sennhauser, F.H., Neu, U., Kunzle, T., Grise, L., Gassner, M., Minder, C., Schindler, C., Varonier, H.S., Wuhrich, B and the SCARPOL team. 1997. Respiratory Health and Long-term Exposure to Air Pollutants in Swiss Schoolchildren. American Journal of Respiratory and Critical Care Medicine 1555:1042-49.
Bruckner, J.v. and Weil, W.B. 1999. Biological Factors Which May Influence an Older Child's or Adolescent's Responses to Toxic Chemicals. Regulatory Toxicology and Pharmacology 29: 158-64.
Brunekreef, B. and Holgate, S.T. 2002. Air Pollution and Health. The Lancet 360:1233-42.
Burr, M.L., Anderson, H.R., Austin, J.B., Harkins, L.S., Kaur, B., Strachan, D.P. and Warner, J.O. 1999. Respiratory Symptoms and Home Environment in Children: A National Survey. Thorax 54: 27-32.
Coetzee, AM., Smith, F.C.A, Van der Merwe, C.A, Dreyer, RJ. 1986. Die Invloed van Lugbesoedeling op Gesondheid in die Sasolburg-gebied. Suid Afrikaanse Mediese Tydskrif 70:339-43.
Cohen Hubal, E.A, Sheldon, L.S., Burke, J.M., McCurdy, T.R, Berry, M.R, Rigas, M.L. 2000. Children's Exposure Assessment: A Review of Facts Influencing Children's Exposure and the Data Available to Characterise and Access that Exposure. Environmental Health Perspectives 108(6): 475-586.
Coombs, M. (ed.). 2000. Medical and Environmental Surveillance Guidelines.
ISBN 1-919727-14-0: 14-16.
Davis, D.L., Bell, M.L. and Fletcher, T. 2002.
A
Look Back at the London Smog of 1952 and the Half Century Since. Environmental Health Perspectives110(12): A734-75.
De Kock RG., Terblanche P. and Annegarn H.J. 1992. Air Pollution Health Research in South Africa: Yesterday and Today. gth World Clean Air Congress Montreal Canada 30 August - 4 September 1992.
Department of Environmental Affairs and Tourism (DEAT). 1998. Maximum Allowable Concentrations for the More Common Pollutants: South African Limits.
Document ESM16/0159/0694.
Department of Environmental Affairs and Tourism (DEA T). 2001. Adoption of Revised Guidelines for Sulphur Dioxide in terms of the Atmospheric Pollution Prevention Act of 1965. Government Gazette no 1387.
Department of Health (DoH). 1990. Information Brochure written by the Department for the Vaal Triangle Air Pollution and Health study. No number or author given.
Department of Health (DoH). 2003. Notifiable Medical Conditions [On line] Available http://www.doh.gov.za/facts/index.html[28 October 2003].
Department of Health (DoH). 2000. Statistical Notes. 2(19) [Online] Available http://www.doh.gov.za/facts/stats-notes/2000/stat19-00.html[25 May 2004].
Department of Health (DoH). 2000a. Statistical Notes. 2(14) [Online] Available http://www.doh.gov.za/facts/index.html[25 May 2004].
Department of Health. (DoH). 2000b. Statistical Notes. 2(18) [Online] Available http://www.doh.gov.za/facts/index.html[25 May 2004].
Department of Health (DoH). 2003. Notification System in a Nutshell. [On line]
Available http://www.doh.gov.za/docs/misclepicommentlnotify.html[6 May 2003].
Department of Water Affairs and Forestry (DWAF). 2003. Review of Cholera Interventions Strategies in KwaZulu-Natal South Africa. DWAF Report prepared by CSIR and HSRC.
Dockery, D.W., Pope, C.A. Ill, Xu, X., Spengler, J.D., Ware, J.H., Fay, M.E., Ferris, B.G.(jr). and Speizer, F.E. 1993. An Association between Air Pollution and Mortality in Six U. S. Cities. New England Journal of Medicine. 329: 1753-59.
Dominici, F., McDermott, A., Daniels, M., Zeger, S.L. and Samet, J.M. 2002. A Report to The Health Effects Institute: Reanalyses of the NMMAPS Database
[Online] Available http://www.biostat.jhsph.edu/-fdominic/HEllnmmaps.html.
Dyer, O. 2003. Environmental Hazards Kill Five Million Children a Year. British Medical Journal 326(7393): 782.
Eaton, L. 2003. World Cancer Rates Set to Double by 2020. British Medical Journal 326(7392): 728a.
Ehrlich, RI., White, N., Norman, R, Laubcher, R, Steyn, K., Lombard, C. and Bradshaw, D. 2004. Predictors of chronic bronchitis in South Africa. International Journal of Tuberculosis and Lung Disease 8(3): 369-76.
Engelbrecht, JP., Reddy, V.S., Swanepoel, L., Mostert, J.C., Stuckenberg, 8., De Beer, Hand Jones-Watson, E.A 1993. The Establishment of Chemical Source Profiles and . their Application to the Apportionment of Aerosols in the Vaal Triangle. Mintek Communication C2023M.
Falkner, B. 2004. New US Guidelines for Hypertension in Children and Adolescents National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents. American Society of Hypertension 19th Annual Scientific Meeting. [Online] Available
http://www.medscape.com/viewarticle/479474 [24 June 2004].
Ferris 8.G. 1978. Epidemiology Standardization Project. Contract No 1-HR-5-302B.
Report HR-5302B-F. Division of Lung Diseases, National Heart, Lung and Blood Institute, USA.
Garrison, J.R 2001. Selected Key studies on Particulate Matter and health: 1997- 2001. American Lung Association [Online] Available http://www.lungusa.org [February 2004].
Gent, J.F., Triche, E.W., Holford, T.R, Belanger, K., Bracken, M.B., ·Beckett, W.S:, and Leaderer, B.P. 2003. Association of Low- Level Ozone and Fine Particles With Respiratory Symptoms in Children With Asthma. Journal of the American Medical Association 290( 14): 1859-67
Gulland, A 2002. Air Pollution Responsible for 600 000 Premature Deaths Worldwide. British Medical Journal 325(7377): 1380c.
Hall, AJ. and Wild, C.P. 2003. Liver Cancer in Low and Middle Income Countries.
British Medical Journal 326(7397): 994.
Hoek, G., Brunekreef, B., Goldbohm, S., Fischer, P. and Van der Brandt, P.A. 2002.
Association between Mortality and Indicators of Traffic-Related Air Pollution in
(
The Netherlands: A Cohort Study. The Lancet 360: 1203-09. . Holgate, T. 1997. The Cellular and Mediator Basis of Asthma in Relation to Natural
History. The Lancet 350(11): 5-9.
Horak, E., Lanigan, A, Roberts, M., Welsh, L., Wilson, J., Carlin, J.B., Olinsky, A, and Robertson, C.F. 2003. Longitudinal Study of Childhood Wheezy Bronchitis and Asthma: Outcome at Age 42. British Medical Journal 326(7386): 422-23.
Hosmer, D.W.(Jr) and Lemeshow, S. 1989. Applied Logistic Regression. John Wiley
& Sons, New York. ISBN 0-471-61553-6: 86.
Hunter, P.R., Davies., M.A., Hill, K., Whittaker, M. and Sufi, F. 2003. The Prevalence of Self-Reported Symptoms of Respiratory Disease and Community Belief about the Severity of Pollution from Various Sources. International Journal of Environmental Health Research. 13(3): 227-38.
Huovinen, E., Kaprio, J. and Koskenvuo, M. 2003. Factors Associated to Lifestyle and Risk of Adult Onset Asthma. Respiratory Medicine 97(3): 273-80.
IJsselmuiden, C. 1997. Ethical Aspects of Epidemiology Research (In Katzenellenbogen, J.M., Joubert, G. and Abdool Karim, S.S., (eds.).
Epidemiology: a Manual for South Africa). ISBN 0-19-571308-7: 25-34.
Joubert, G. and Katzenellenbogen, J.M. 1997. Study Design and Sampling (In Katzenellenbogen, J.M., Joubert, G. and Abdool Karim, S.S., (eds.).
Epidemiology: a Manual for South Africa). ISBN 0-19-571308-7: 69-70; 80-81. Katzenellenbogen, J.M. and Yach, 0.1991. Introduction (In Katzenellenbogen, J.M.,
Joubert, G. and Yach, D. Introductory Manual for Epidemiology in Southern Africa). ISBN 1 874826056: 3.
Katzenellenbogen, J.M. and Joubert, G. 1997. Data Collection and Measurement (In Katzenellenbogen, J.M., Joubert, . G. and Abdool Karim, S.S., (eds.).
Epidemiology: a Manual for South Africa). ISBN 0-19-571308-7: 82-94.
Koenig, J.Q., and Mar, J.F. 2000. Sulphur dioxide: Evaluation of Current California Air Quality Standards with Respect to Protection of Children. [Online] Available:
www.arb.ca.gov/ch/ceh/agstandards/oehhas02.contractorreport091200. pdf.
[6 March 2003].
Kramer, U., Heinrich, J., Wjst, M. and Wichmann, H.E. 1999. Age of Entry to Day Nursery and Allergy in Later Childhood. The Lancet 353(9151): 450-54.
Kurukulaaratchy, R.J., Matthews, S., Holgate, S.T. and Arshad, S.H. 2003. Predicting Persistent Disease among Children who Wheeze during Early Life. European Respiratory Journa/22: 767-71.
Kustner, H.G.V. 1995. Epidemiological Comments 22(1): 18.
Kustner, H.G.v. 1980. Surveillance as it Pertains to Community Health in the Republic of South Africa. MD Thesis, University of Pretoria, South Africa: 1,53,77, 100,101,110,300,301 ..
Lalloo, U.G., Bateman, E.D., Feldman, C., Bardin, P.G., Plit, M., Irusen, E.M. and O'Brien, J. 2000. Guideline for the Management of Chronic Asthma in Adults - 2000 update. South African Medical Journal 90(5): 540-52.
Landrigan, P.J., Carlson, J.E., Bearer, C.F., Cranmer, J.F., Bullard, RD., Etzel, RA, Groopman, J., McClachlan, J.A, Perera, F.P., Keigart, J.R, Robinson, L., Schell, L. and Sur, W.A 1998. Children's Health and the Environment: A new Agenda for Prevention Research. Environmental Health PerspectiVes: 106(3): 1-14.
Lippmann, M. 1992. Ozone (In Lippmann, M. (ed.). Environmental Toxicants: Human Exposures and Their Health Effects). Van Nostrand Reinhold, New York.
ISBN 0-442-00549-0: 465.
Lippmann, M. 2003. Air Pollution and Health-Studies in the Americas and Europe (In McGranahan, and Murray, F. (eds). Air pollution & Health in Rapidly Developing Countries). Earthscan, London. ISBN: 185383985:37,38,41.
Martin, B.W., Ackermann-Liebrich, U., Leuenberger, P., KGnzli, N., Zemp Stutz, E., Keller, R, Zellweger J.P., Wuthrich, B., Monn, C., Blaser, K.,
B%gnini, G., Bongard, J.P., Brandli, 0., Braun, P., Defila, C.,
Domenighetti, G., Grize, L., Karrer, W., Keller-Wossidlo, H., Medici, T.C., Peeters, A, Perruchoud, AP., Schindler, C., Elsasser, S., Schoeni, M.H.,
Schwartz, J.,Solari, G., Tschopp, J-M., Villiger, B., 1997. SAPALDIA: Methods and participation in the cross-sectional part of the Swiss Study -on Air Pollution and Lung Disease In Adults Sozial-und Praventivmedizih. 42: 67-84.
Mathee, A and Von Schirnding, Y. 2003. Air Quality and Health in Greater Johannesburg (In McGranahan, G. and Murray, F (eds). Air pollution & Health in Rapidly Developing Countries). Earthscan, London. ISBN 185383985:
209,210,211.
Medical Research Council (MRC) 2001/2002 Annual Report. [On line] Available http://www.mrc.ac.zalannualreportiannual.html[6 May 2003].
Murray, F. and McGranahan, G. 2003. Air pollution and Health in Developing Countries - the Context (In McGranahan, G. and Murray, F (eds). Air pollution &
Health in Rapidly Developing Countries) Earthscan, London. ISBN 185383985:
2,6,9.
Nriagu, J., Robins, T., Gary, L., Liggans, G., Davila, R, Supuwood, K., Harvey, C., Jinabhai, C. and Naidoo R 1999. Prevalence of Asthma and Respiratory Symptoms in South-central Durban, South Africa. European Journal of Epidemiology: 15: 747-55.
O'Hollaren, M.T. 2003. The Development and Prevention of Allergic Disease.
Highlights of the American Col/ege of Allergy, Asthma & Immunology 2003 Annual Meeting [Online] Available http://lwww.medscape.com/viewarticle/468786 [1 March 2004].
O'Neill, M.S., Jerrett, M., Kawachi, I., Levy, J.I., Cohen, AJ., Gouveia, N., Wikinson, P., Fletcher, T., Cifuentes, L. and Schwartz, J. 2003. Health, Wealth,and Air Pollution: Advancing Theory and Methods. Environmental Health Perspectives 111(16): 1861-70.
Opperman, L., Terblanche, A.P.S., Nel, C.M.E., Nyikos, H. 1991. Personal Monitoring of total suspended particulate matter in the Vaal Triangle.
Proceedings of NACA Conference: Air Pollution and the Environment, Durban, South Africa.
Ott, W.R 1995. Human Exposure Assessment: The Birth of a New Science. Journal of Exposure Analysis and Environmental Epidemiology 5(4): 449-72.
Ozkaynak, H., Xue, J and Spengler, J.D. 1994. Analysis of Health and Pollution Data Collected from Transvaal, South Africa (Phase 11 and Ill) Report prepared for the VAPS study (unpublished).
Pascual, E and Pedraz, T. 2004. Gout Current Opinion in Rheumatology. [Online]
Available http://www.medscape.com/viewarticle/475056?src=mp [27 May 2004].
Pluddemann, A. 2001. The Sbuth African Community Epidemiology Network on Drug Use - SACENDU (Phase 8) - A Gauteng Focus. Urban Health and Development Bulletin 40(1). [On line] Available
http://www.mrc.ac.za/urbanbulletin/march2001/sacendu.htm [6 May 2003].
Pope C.A Ill, Thun, M.J., Namboodiri, M.M., Douglas, W., Dockery, D.W., Evans, J.S., Speizer, F.E. and Heath, C.W.Or). 1995. Particulate Air Pollution as a Predictor of Mortality in a Prospective Study of U. S. Adults. American Journal of Respiratory and Critical Care Medicine. 151: 669-74.
Pope C. A Ill, Burnett, RT., Thun, M. J., Calle, E.E., Krewski, D., Ito, K. and Thurston,G. D. 2002. Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution Journal of the American Medical Association 287: 1132-41.
Radon, K., BGsching, K.,· Heinrich, J., Wichmann, H.E., Jorres, R.A, Magnussen, H.
and Nowak, D. 2002. Passive Smoking Exposure A Risk Factor for Chronic Bronchitis and Asthma in Adults? Chest 122: 1086-90.
Ramadour, M., Burel, C., Lanteaume, A, Vervloet, D., Charpin, D., Brisse, F. and Dutau, H. 2000. Prevalence of Asthma and Rhinitis in relation to Long'-term Exposure to Gaseous Air Pollutants. Allergy 55: 1163-69.
Reddy, V.S., Engelbrecht, J.P., Swanepoel, L. and Mostert, J.C. 1996. Airborne Particulate Matter Monitoring and Source Apportionment in the Urban Areas of the Vaal Triangle, Olifantsfontein, Nelspruit and Randburg. 21h Annual Clean Air
Conference Badplaas, 20-22 November 1996.
Republic of South Africa, 1965. The Atmospheric Pollution Prevention Act (Act number 45 of 1965). Government Printer Pretoria.
Republic of South Africa, 1996. Constitution of the Republic of South Africa (Act number 108 of 1996) Government Printer Cape Town.
Republic of South Africa, 1999. Tobacco Products Control Amendment Act (Act number 12 of 1999) Government Printer Pretoria.
Rizvi, AA 2004. Type 2 Diabetes: Epidemiologic Trends, Evolving Pathogenic Concepts, and Recent Changes in Therapeutic Approach. Southern Medical Journal 97(11): 1079-87. [Online] Available
http://www.medscape.com/viewarticle/494580?src=mp [16 December 2004].
Romieu, I. and Hernandez-Avila, M. 2003. Air Pollution and Health in Developing Countries: A Review of Epidemiological Evidence. (In McGranahan, G. and Murray, F. (eds). Air pollution & Health in Rapidly Developing Countries).
Earthscan, London. ISBN 185383985: 49, 58.
Sasol and Eskom. 2004. Air Quality Monitoring Data from Stations in the Vaal Triangle (unpublished).
Schwela, D. 2003. Local Ambient Air Quality Management (In McGranahan, G. and Murray, F (eds) Air pollution & Health in Rapidly Developing Countries).
Earthscan, London. ISBN185383985: 70.
Scorgie, Y., Kneen, M.A, Annegarn, H.J. and Burger, L.W. 2003. Air Pollution in the Vaal Triangle- Quantifying Source Contributions and Identifying Cost-effective Solutions. Proceedings of the National Conference of the National Association for Clean Air (NACA), Vanderbijlpark, October 2003.
Sears, M.R, Greene, J.M., Willan, AR, Wiecek, E.M., Taylor, D.R., Flannery, E.M., Cowan, J.O., Herbison, G.P., Silva, P.A and Poulton, R 2003. A Longitudinal, Population-based, Cohort Study of Childhood Asthma followed to Adulthood. New England Journal of Medicine 349(15): 1414-22.
Sexton, K., Selevan, S.G., Wagener, OK, Lybarger, J.A 1992. Estimating Human Exposure to Environmental Pollutants: Availability and Utility of Existing Databases. Archives of Environmental Health: 47(6): 398-407.
Sitas, F., Madhoo, J.and Wessie, J. 1998. Incidence of Histologically Diagnosed Cancer in South Africa, 1993-1995. National Cancer Registry S.A Institute for Medical Research.
Smith, K.R and Akhar, S. 2003. Health-Damaging Air Pollution: A Matter of Scale (In McGranahan, G. and Murray, F (eds). Air pollution & Health in Rapidly Developing Countries). Earthscan, London. ISBN 185383985: 21,25,30.
South Africa Yearbook 2003/2004. [Online] Available
http://www.gcis.gov.za/docs/publications/yearbook.htm: 389-95 [13 May 2004]
South African Demographic and Health Survey (SADHS). 1998. ISBN Q-621-31456-X:
xii, 169, 171,172,196,197,201,212,213,223,227 ,231,234,239,241245,247. [Online]
Available http://www.doh.gov.zalsearch/index.html[28 October 2003].
Statistics South Africa 2001. Census in Brief. Report no:03-02-03.
Statistics South Africa 2002. Stats in Brief 2002. ISBN 0-621-32899-5: 67.
Sporik, Rand Platts-Mills, T.A.E. 2001. Allergen Exposure and the Development of Asthma. Thorax 56(2): ii58-ii63.
Sumer, T. 2004. Outgrowing Childhood Asthma. Medscape Allergy and Clinical Immunology(2). [Online] Available
http://www.medscape.com/viewarticle/482720 print [22 July 2004].
Taussig, L.M., Wright, AL., Holberg, C.J., Halonen, M., Morgan, W.J. and Martinez, F.D. 2003. Tucson Children'S Respiratory Study: 1980 to Present. Journal of Allergy and Clinical Immunology 111 (4): 661-75.
Terblanche P. 1991 Vaal Triangle Air Pollution Health Study Progress Report 1990.
Report number 7/90.
Terblanche AP.S, Srnit H.E. and Uys L. 1991a. Personal MonitOring of Total Suspended Particulates in South Africa. Presentation at the 84h Annual Meeting of the Air and Waste Management Association. 16 - 21 June 1991.
Terblanche P., Opperman L. and Nel R 1992. Vaal Triangle Air Pollution Health Study Progress Report 1991. Report number 10/91.
Terblanche AP.S., Opperman L., Nel C.M.E., Reinacti S.G., Tosen G. and Cadman A 1992a. Preliminary Results of Exposure Measurement and Health Effects of the Vaal Triangle Air Pollution Health Study. South African Medical Journal. 81:
550-56.
Terblanche P., Nel R, Opperman L. and Nyikos H. 1992b. Exposure to Air Pollution from Transitional Domestic Fuels in a South African Population. Presented at the Fourth Annual Meeting of the International Society for Environmental Epidemiology and the International Society of Exposure Analysis. Cuernavaca, Morelos, Mexico, 26 - 29 August 1992.
Terblanche P., Opperman L. and Nel R 1993: Vaal Triangle Air Pollution Health Study Progress Report 1992. Report number 11/92.
Terblanche, P. 1998. Vaal Triangle Air Pollution Health Study: Bibliography, Summary of Key Findings and Recommendations. ISBN 1-874826-89-7.
Tosen, G. R, Terblanche, AP.S., Uys, L. and Turner, C.R 1992. Design and Operation of an Ambient Air Pollution Monitoring Network in the Vaal Triangle Air Pollution Health Study. The Clean Air Journal 18(6): 10.
Tosen G and Rorich R 1992a. Observed Variations in Outdoor Gaseous and Particulate Concentrations for 1990/91 in the Vaal Triangle Region. National NACA Conference 8 -10 November 1992 - Vaal Triangle.
US-EPA 1996. Inhalation (In Exposures Factors Handbook Volume I-General Factors): 3-20, 5-13. EPN600/8-89/043.
Van Graan J. 2003. Air Pollution Control Officer DEAT. Personal communication, April 2003.
Watts, G. 2003 Huge Numbers Must Change Lifestyle to Prevent Epidemic of Diabetes. British Medical Journal 327(7428): 1365a.
Watts, G. 2004. The Defence of Dirt. British Medical Journa/328(7 450): 1226.
Wesley, AG. and Loening, W.E. 1996. Assessment and 2-year Follow-up of some Factors associated with Severity of Respiratory Infections in Early Childhood.
South African Medical Journal 86(4): 365-8.
Whelan, J. 2002. WHO Calls for Countries to Shift from Acute to Chronic Care.
British Medical Journal 324(7348): 1237.
World Health Organisation (WHO). 1992. Our Planet Our Health; Report of the WHO Commission on Health and Environment. ISBN 9241561483.
World Health Organisation (WHO). 2000. Air Pollution Fact Sheet no 187. [Online]
Available: http://222.who.intlinf/inf-fs/en/fact187.html [6 March 2003].
World Health Organisation (WHO). 2002. The World Health Report 2002: Reducing Risks, Promoting Healthy Ufe. [Online] Available:http://www.who.intlwhr/2002/en/
[16 April 2003].
World Health Organisation (WHO) 2003 Africa Malaria Report [Online] Available http://www.rbm.who.int/amd2003/amr2003/ch1.htm [10 May 2004].
Zemp, E., Elsasser, S., Schindler, C., Kunzli, N., Perruchoud, A.P., Domenighetti, G., Medici, T., Ackermann-Uebrich, U., Leuenberger, P., Monn, C., Bolognini, G., Bongard, J.P., Brandli, 0., Karrer, W., Keller, R., Schoni, M.H., Tschopp, J-M., Villiger, B., Zellweger J.P. 1999. Long-term Ambient Air Pollution and Respiratory Symptoms in Adults (SAPALDIA study). American Journal of Respiratory and Critical Care Medicine. 159: 125-'-66.
Zwi, S., Goldman, H.I., Kallenbach, J.M., Davies, J.C.A., B'eddake, M.R. and Reinach, S.G. 1991. Respiratory Health Status of Children in the Eastern , Transvaal Highveld. The Clean Air Journa/8(3}; 11-21.
APPENDIX A: LETTER OF CONSENT AND QUESTIONNAIRE USED IN THE STUDY
Letter of Consent
Dear Participant,
The University of Natal, in collaboration with CSIR and other organisations, is currently conducting a study on air pollution and associated health effects. The study will contribute towards an M Med Sci degree at the University of Natal.
One of the aims of the study is to provide decision support to national authorities in revising air pollution standards for South Africa. Questionnaires are being distributed to a population of individuals who participated in a similar study in 1990, of whom you are one. The information provided by participants is therefore of the utmost importance for the success of the study.
Information is needed regarding your health status, your occupation and the home you live in as well as on your current life style and activities. There are no potential risks to participants as all information will be treated as confidential and will be used for research purposes only. Only overall results will be reported and no reference will be made to any individual's information. Participation in the current study is voluntary.
If you are willing to participate in this study, please sign this form and.send it back in the enclosed envelope, together with the completed questionnaire.
Kind regards,
Rietha Oosthuizen.
I hereby declare that I am aware of what the study is about and grant permission that the information provided by me in the questionnaire may be used for research purposes.
Signature (participant)
For further information, please contact:
Mrs M A Oosthuizen Environmentek - CSIR PO Box 395
Pretoria 0001
e-mail: roosthui@csir.co.za Tel no: (012) 841 2035 Fax no: (012) 841 2689
Please print name and surname